Endodontic flare-ups incidence and related factors

Hye-Young Jung; Sang-Hyuk Park; Gi-Woon Choi

doi:10.5395/JKACD.2005.30.2.102

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Original Article Endodontic flare-ups incidence and related factors: Hye-Young Jung¹, Sang-Hyuk Park^1,2, Gi-Woon Choi^1,2; 2005;30(2):-111.
DOI: https://doi.org/10.5395/JKACD.2005.30.2.102
Published online: March 31, 2005

¹Department of Conservative Dentistry, Division of Dentistry, Graduate School, Kyunghee University, Korea.

²Oral Biology Research Institute, College of Dentistry, Kyunghee University, Korea.

Corresponding author: Gi-Woon Choi. Department of Conservative Dentistry, Division of Dentistry, Graduate school of KyungHee University, 1, Hoegi Dong, Dongdaemoon Gu, Seoul, Korea, 130-702. Tel: 82-2-958-9336, gwchoi@khu.ac.kr

• Received: September 3, 2004 • Revised: December 13, 2004 • Accepted: December 18, 2004

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Abstract
REFERENCES

Abstract

The purpose of this study was to assess the incidence of flare-ups among patients who received endodontic treatment and to examine the correlation with pre-operative and operative variables.

Analysis was in two aspects (a) overall incidence of flare-ups as expressed by a percentage of all patients visits and (b) percentage of flare-ups that occurred as related to various factors such as patient demographics, diagnosis, and treatment procedures.

1. From the 840 teeth which were examined in this study, the total number of flare-ups was 13.

2. As to gender of patients, there was no significant difference in flare-ups.

3. As to tooth groups, there was no significant difference in flare-ups.

4. In the teeth with pre-operative symptom, there was a statistically significant higher incidence of flare-ups than the teeth without it.

5. In the teeth with apical periodontitis, there was a statistically significant higher incidence of flare-ups.

6. As to pulp and periapical status, non-vital teeth had a higher incidence as compared with vital teeth, irreversible pulpitis.

7. Multi-visit treatment resulted in the higher incidence of flare-ups than one visit treatment.

8. Re-treatment procedures had a statistically significant higher incidence of flare-ups than root canal treatment.

In this study, overall percentages of flare-ups was 1.55%. It showed a statistically significant higher incidence related to pre-operative symptom, apical periodontitis, and re-treatment. There was no significant difference in flare-ups related to gender, tooth groups, and fistula.
Keywords: Flare-up; Endodontic treatment; Incidence; Pre-operative variables

Table 1

Endodontic treatment chart for surveying flare-up incidence

^†RCT: root canal treatment

RE: re-treatment

Table 2

Flare-up according to gender^*

^*Not statistically significant at P < 0.05

Table 3

Flare-up in different tooth group^*

^*Not statistically significant at P < 0.05

Table 4

Flare-up related to pain and swelling^*

^*Statistically significant at P < 0.05

Table 5

Flare-up related to peri-radicular diagnosis^*

^*Statistically significant at P < 0.05

Table 6

Flare-up related to pus discharge^*

^*Statistically significant at P < 0.05

Table 7

Flare-up related to fistula^*

^*Statistically significant at P < 0.05

Table 8

Flare-up related to pulpal state^*

^*Statistically significant at P < 0.05

^†Irre. = Irreversible

Table 9

Flare-up according to the No. of appointments^* and pre-treatment status

^*Not statistically significant at P < 0.05

There was a statistically significant difference according to periapical lesion in the multi-visit treatment.

Table 10

Flare-up according to type of treatment^* and pre-treatment status

^*Statistically significant at P < 0.05

There was not a statistically significant difference in root canal treatment.

Table 11

Flare-up according to Ca(OH)₂ dressing^*

^*Not statistically significant at P < 0.05

REFERENCES

1. American Association of Endodontists. Glossary: Contemporary Terminology for Endodontics. 1998;6th ed. Chicago: The Association.
2. Walton RE, Torabinejad M. Endodontic Emergencies. Principle and Practice of Endodontics. 1996;2nd ed. Philadelphia, PA: W.B. Saunders; 300-305.
3. Mor C, Rotstein I, Friedman S. Incidence of Interappointment Emergency Assoiciated with Endodontic Therapy. J Endod. 1992;18: 509-511.PubMed
4. Barnett F, Tronstad L. The Incidence of Flare-ups Following Endodontic Treatment. J Endod. 1989;15: 181-182.
5. Imura N, Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J. 1995;28: 261-265.Article PubMed
6. Balaban FS, Skidmore AE, Griffin JA. Acute Exacerbations Following Initial Treatment of Necrotic Pulps. J Endod. 1984;10: 78-81.Article PubMed
7. Mata E, Koren LZ, Morse DR, Sinai IH. Prophylactic use of penicillin V in teeth with necrotic pulps and asymptomatic periapical radiolucencies. Oral Surg Oral Med Oral Pathol. 1985;60: 201-207.Article PubMed
8. Siqueira JF, Rôças IN, Favieri A, Machado AG, Gahyva SM, Oliveira JM, Abad EC. Incidence of Postoperative Pain After Intracanal Procedures Based on an Antimicrobial Strategy. J Endod. 2002;28: 457-460.Article PubMed
9. Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS. Factors Associated with Endodontic Interappointment Emergencies of Teeth with Necrotic Pulps. J Endod. 1988;14: 261-266.Article PubMed
10. Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol. 1990;6: 226-229.Article PubMed
11. Trope M. Flare-up rate of single-visit endodontics. Int Endod J. 1991;24: 24-26.Article PubMed
12. Walton R, Fouad A. Endodontic interappointment flare-ups: a prospective study of incidence and related factors. J Endod. 1992;18: 172-177.Article PubMed
13. Seltzer S, Naidorf IJ. Flare-ups in Endodontics: Etiological Factors. J Endod. 1985;11: 472-478.PubMed
14. Seltzer S. Pain in Endodontics. J Endod. 1986;12: 505-508.Article PubMed
15. Siqueira JF. Microbial causes of endodontic flare-ups. Int Endod J. 2003;36: 453-463.Article PubMed PDF
16. Morse DR, Furst ML, Belott RM, Lefkowitz RD, Spritzer IB, Sideman BH. Infectious flare-ups and serious sequelae following endodontic treatment: A prospective randomized trial on efficacy of antibiotic prophylaxis in cases of asymptomatic pulpal-periapical lesions. Oral Surg Oral Med Oral Pathol. 1987;64: 96-109.Article PubMed
17. Fox J, Atkinson JS, Dinin AP, Greenfield E, Hechtman E, Reeman CA, Salkind M, Todaro CJ. Incidence of pain following one-visit endodontic treatment. Oral Surg Oral Med Oral Pathol. 1970;30: 123-130.Article PubMed
18. Rimmer A. The Flare-Up Index: A Quantitative Method to Describe the Phenomenon. J Endod. 1993;19: 255-256.Article PubMed
19. Eleazer PD, Eleazer KR. Flare-Up Rate in Pulpally Necrotic Molars in One-Visit Versus Two-Visit Endodontic Treatment. J Endod. 1998;24: 614-616.Article PubMed
20. Alaçam T. Interappointment Emergencies in Teeth with Necrotic Pulps. J Endod. 2002;28: 375-377.Article PubMed
21. Marshall JG, Walton RE. The Effect of Intramuscular Injection of Steroid on Posttreatment Endodontic Pain. J Endod. 1984;10: 584-588.Article PubMed
22. Mulhern JM, Patterson SS, Newton CW, Ringel AM. Incidence of postoperative pain after one-appointment endodontic treatment of asymptomatic pulpal necrosis in single-rooted teeth. J Endod. 1982;8: 370-375.Article PubMed
23. Lin L, Shovlin F, Skribner JE, Langeland K. Pulp biopsies from teeth associated with periapical radiolucency. J Endod. 1984;10: 436-448.PubMed
24. Stephen C, Richard CB. Orofacial Dental Pain Emergencies. 2002;Pathways of the pulp 8th ed. Mosby; 61-68.
25. Roane JB, Dryden JA, Grimes EW. Incidence of postoperative pain after single- and multiple-visit endodontic procedures. Oral Surg Oral Med Oral Pathol. 1983;55: 68-72.Article PubMed
26. Marshall JG, Liesinger AW. Factors Associated with Endodontic Posttreatment Pain. J Endod. 1993;19: 573-575.Article PubMed
27. Wolfson EM, Seltzer S. Reaction of rat connective tissue to some gutta- percha formulations. J Endod. 1975;1: 395-402.Article PubMed
28. Byström A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 1985;1: 170-175.Article PubMed
29. Walton RE, Holton IF, Michelich R. Calcium Hydroxide as an Intracanal Medication: Effect on Posttreatment Pain. J Endod. 2003;29: 627-629.Article PubMed
30. Torabinejad M, Dorn SO, Eleazer PD, Frankson M, Jouhari B, Mullin RK, Soluti A. Effectiveness of Various Medications on Postoperative Pain following Root Canal Obturation. J Endod. 1994;20: 427-431.Article PubMed

Tables & Figures

Table 1

Endodontic treatment chart for surveying flare-up incidence

^†RCT: root canal treatment

RE: re-treatment

Table 2

Flare-up according to gender^*

^*Not statistically significant at P < 0.05

Table 3

Flare-up in different tooth group^*

^*Not statistically significant at P < 0.05

Table 4

Flare-up related to pain and swelling^*

^*Statistically significant at P < 0.05

Table 5

Flare-up related to peri-radicular diagnosis^*

^*Statistically significant at P < 0.05

Table 6

Flare-up related to pus discharge^*

^*Statistically significant at P < 0.05

Table 7

Flare-up related to fistula^*

^*Statistically significant at P < 0.05

Table 8

Flare-up related to pulpal state^*

^*Statistically significant at P < 0.05

^†Irre. = Irreversible

Table 9

Flare-up according to the No. of appointments^* and pre-treatment status

^*Not statistically significant at P < 0.05

There was a statistically significant difference according to periapical lesion in the multi-visit treatment.

Table 10

Flare-up according to type of treatment^* and pre-treatment status

^*Statistically significant at P < 0.05

There was not a statistically significant difference in root canal treatment.

Table 11

Flare-up according to Ca(OH)₂ dressing^*

^*Not statistically significant at P < 0.05

REFERENCES

1. American Association of Endodontists. Glossary: Contemporary Terminology for Endodontics. 1998;6th ed. Chicago: The Association.
2. Walton RE, Torabinejad M. Endodontic Emergencies. Principle and Practice of Endodontics. 1996;2nd ed. Philadelphia, PA: W.B. Saunders; 300-305.
3. Mor C, Rotstein I, Friedman S. Incidence of Interappointment Emergency Assoiciated with Endodontic Therapy. J Endod. 1992;18: 509-511.PubMed
4. Barnett F, Tronstad L. The Incidence of Flare-ups Following Endodontic Treatment. J Endod. 1989;15: 181-182.
5. Imura N, Zuolo ML. Factors associated with endodontic flare-ups: a prospective study. Int Endod J. 1995;28: 261-265.Article PubMed
6. Balaban FS, Skidmore AE, Griffin JA. Acute Exacerbations Following Initial Treatment of Necrotic Pulps. J Endod. 1984;10: 78-81.Article PubMed
7. Mata E, Koren LZ, Morse DR, Sinai IH. Prophylactic use of penicillin V in teeth with necrotic pulps and asymptomatic periapical radiolucencies. Oral Surg Oral Med Oral Pathol. 1985;60: 201-207.Article PubMed
8. Siqueira JF, Rôças IN, Favieri A, Machado AG, Gahyva SM, Oliveira JM, Abad EC. Incidence of Postoperative Pain After Intracanal Procedures Based on an Antimicrobial Strategy. J Endod. 2002;28: 457-460.Article PubMed
9. Torabinejad M, Kettering JD, McGraw JC, Cummings RR, Dwyer TG, Tobias TS. Factors Associated with Endodontic Interappointment Emergencies of Teeth with Necrotic Pulps. J Endod. 1988;14: 261-266.Article PubMed
10. Trope M. Relationship of intracanal medicaments to endodontic flare-ups. Endod Dent Traumatol. 1990;6: 226-229.Article PubMed
11. Trope M. Flare-up rate of single-visit endodontics. Int Endod J. 1991;24: 24-26.Article PubMed
12. Walton R, Fouad A. Endodontic interappointment flare-ups: a prospective study of incidence and related factors. J Endod. 1992;18: 172-177.Article PubMed
13. Seltzer S, Naidorf IJ. Flare-ups in Endodontics: Etiological Factors. J Endod. 1985;11: 472-478.PubMed
14. Seltzer S. Pain in Endodontics. J Endod. 1986;12: 505-508.Article PubMed
15. Siqueira JF. Microbial causes of endodontic flare-ups. Int Endod J. 2003;36: 453-463.Article PubMed PDF
16. Morse DR, Furst ML, Belott RM, Lefkowitz RD, Spritzer IB, Sideman BH. Infectious flare-ups and serious sequelae following endodontic treatment: A prospective randomized trial on efficacy of antibiotic prophylaxis in cases of asymptomatic pulpal-periapical lesions. Oral Surg Oral Med Oral Pathol. 1987;64: 96-109.Article PubMed
17. Fox J, Atkinson JS, Dinin AP, Greenfield E, Hechtman E, Reeman CA, Salkind M, Todaro CJ. Incidence of pain following one-visit endodontic treatment. Oral Surg Oral Med Oral Pathol. 1970;30: 123-130.Article PubMed
18. Rimmer A. The Flare-Up Index: A Quantitative Method to Describe the Phenomenon. J Endod. 1993;19: 255-256.Article PubMed
19. Eleazer PD, Eleazer KR. Flare-Up Rate in Pulpally Necrotic Molars in One-Visit Versus Two-Visit Endodontic Treatment. J Endod. 1998;24: 614-616.Article PubMed
20. Alaçam T. Interappointment Emergencies in Teeth with Necrotic Pulps. J Endod. 2002;28: 375-377.Article PubMed
21. Marshall JG, Walton RE. The Effect of Intramuscular Injection of Steroid on Posttreatment Endodontic Pain. J Endod. 1984;10: 584-588.Article PubMed
22. Mulhern JM, Patterson SS, Newton CW, Ringel AM. Incidence of postoperative pain after one-appointment endodontic treatment of asymptomatic pulpal necrosis in single-rooted teeth. J Endod. 1982;8: 370-375.Article PubMed
23. Lin L, Shovlin F, Skribner JE, Langeland K. Pulp biopsies from teeth associated with periapical radiolucency. J Endod. 1984;10: 436-448.PubMed
24. Stephen C, Richard CB. Orofacial Dental Pain Emergencies. 2002;Pathways of the pulp 8th ed. Mosby; 61-68.
25. Roane JB, Dryden JA, Grimes EW. Incidence of postoperative pain after single- and multiple-visit endodontic procedures. Oral Surg Oral Med Oral Pathol. 1983;55: 68-72.Article PubMed
26. Marshall JG, Liesinger AW. Factors Associated with Endodontic Posttreatment Pain. J Endod. 1993;19: 573-575.Article PubMed
27. Wolfson EM, Seltzer S. Reaction of rat connective tissue to some gutta- percha formulations. J Endod. 1975;1: 395-402.Article PubMed
28. Byström A, Claesson R, Sundqvist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol and calcium hydroxide in the treatment of infected root canals. Endod Dent Traumatol. 1985;1: 170-175.Article PubMed
29. Walton RE, Holton IF, Michelich R. Calcium Hydroxide as an Intracanal Medication: Effect on Posttreatment Pain. J Endod. 2003;29: 627-629.Article PubMed
30. Torabinejad M, Dorn SO, Eleazer PD, Frankson M, Jouhari B, Mullin RK, Soluti A. Effectiveness of Various Medications on Postoperative Pain following Root Canal Obturation. J Endod. 1994;20: 427-431.Article PubMed

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Endodontic flare-ups incidence and related factors

J Korean Acad Conserv Dent. 2005;30(2):102-111. Published online March 31, 2005

DOI: https://doi.org/10.5395/JKACD.2005.30.2.102

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Endodontic flare-ups incidence and related factors

Table 1

Endodontic treatment chart for surveying flare-up incidence

^†RCT: root canal treatment

RE: re-treatment

Table 2

Flare-up according to gender^*

^*Not statistically significant at P < 0.05

Table 3

Flare-up in different tooth group^*

^*Not statistically significant at P < 0.05

Table 4

Flare-up related to pain and swelling^*

^*Statistically significant at P < 0.05

Table 5

Flare-up related to peri-radicular diagnosis^*

^*Statistically significant at P < 0.05

Table 6

Flare-up related to pus discharge^*

^*Statistically significant at P < 0.05

Table 7

Flare-up related to fistula^*

^*Statistically significant at P < 0.05

Table 8

Flare-up related to pulpal state^*

^*Statistically significant at P < 0.05

^†Irre. = Irreversible

Table 9

Flare-up according to the No. of appointments^* and pre-treatment status

^*Not statistically significant at P < 0.05

There was a statistically significant difference according to periapical lesion in the multi-visit treatment.

Table 10

Flare-up according to type of treatment^* and pre-treatment status

^*Statistically significant at P < 0.05

There was not a statistically significant difference in root canal treatment.

Table 11

Flare-up according to Ca(OH)₂ dressing^*

^*Not statistically significant at P < 0.05

Table 1 Endodontic treatment chart for surveying flare-up incidence

^†RCT: root canal treatment

RE: re-treatment

Table 2 Flare-up according to gender*

^*Not statistically significant at P < 0.05

Table 3 Flare-up in different tooth group*

^*Not statistically significant at P < 0.05

Table 4 Flare-up related to pain and swelling*

^*Statistically significant at P < 0.05

Table 5 Flare-up related to peri-radicular diagnosis*

^*Statistically significant at P < 0.05

Table 6 Flare-up related to pus discharge*

^*Statistically significant at P < 0.05

Table 7 Flare-up related to fistula*

^*Statistically significant at P < 0.05

Table 8 Flare-up related to pulpal state*

^*Statistically significant at P < 0.05

^†Irre. = Irreversible

Table 9 Flare-up according to the No. of appointments* and pre-treatment status

^*Not statistically significant at P < 0.05

There was a statistically significant difference according to periapical lesion in the multi-visit treatment.